Key messages
• Healthcare workers sometimes use their personal mobile (or 'cell') phones informally to plug gaps in the healthcare system.
• Our findings suggest that this can help them work more efficiently. It can also help them be more responsive to patients and health workers' needs.
• However, it can also lead to problems for patients and healthcare workers, and it can weaken the healthcare system.
What is informal mobile phone use?
Healthcare workers sometimes use their personal mobile phones at work even though this use is not formally regulated. This may help them carry out their work when their workplace lacks effective and accessible ways of sharing information through the formal system. But it can also lead to new problems.
What did we want to find out?
We wanted to explore healthcare workers’ informal use of personal mobile phones to support their work.
What did we do?
We searched for studies about healthcare workers’ views, experiences, and practices regarding their personal mobile phone use at work. We analysed their results and assessed our confidence in the review findings.
What did we find?
We found 30 studies published between 2013 and 2022. The studies were from high-, middle- and low-income countries. They explored different types of healthcare workers, including doctors, nurses, lay-health workers, pharmacists and healthcare managers working in hospitals, clinics and the community. Some of our review findings were only based on small amounts of data, which lowered our confidence in these findings. We have moderate to high confidence in the following review findings.
• Healthcare workers are faced with the gap between what is expected of them and the resources available to them. To plug this gap, they develop their own strategies. This sometimes involves using their own mobile phones, data and airtime. They also use their personal time to make and take calls outside working hours, and use their personal networks to contact others for help and advice.
• In some settings, healthcare workers’ personal mobile phone use is unregulated but has become a normal part of many work processes. Some healthcare workers, therefore, feel pressure from colleagues and managers to use their personal phones. Some also use their mobile phones because of feelings of obligation towards their patients and colleagues.
• Healthcare workers’ use of their personal mobile phones, time and networks helps humanise healthcare. It allows healthcare workers to be more flexible, efficient and responsive to the needs of the patient. It can connect patients with individual healthcare workers rather than impersonal systems and can help patients keep sensitive information out of the formal system. It also allows healthcare workers to communicate with each other in more personal ways than formal systems allow. All this can strengthen healthcare workers' relationships with patients and colleagues.
• However, these informal approaches can also cause problems for healthcare workers. Personal mobile phone use costs money. This is a particular problem for lower-level healthcare workers and healthcare workers in low-income settings who are likely to be paid less and may have less access to work phones or compensation. Out-of-hours use may also be more of a burden for lower-level healthcare workers as they may find it harder to ignore calls when they are at home. Healthcare workers with poor access to electricity and the internet are also less able to use informal mobile phone solutions, while healthcare workers with less education may find it difficult to appraise the information they find online. Informal digital channels can help healthcare workers expand their personal networks. However, healthcare workers who rely on personal networks to seek help and advice are at a disadvantage if these networks are weak.
• Healthcare workers’ use of their personal resources can also lead to problems for patients and can benefit some patients more than others. For instance, when healthcare workers store and share patient information on their personal mobile phones, the confidentiality of this information may be broken. Furthermore, healthcare workers may decide to use their personal resources on some types of patients, but not others. Healthcare workers sometimes describe using their mobile phones, time and networks to help patients and clients whom they think are particularly in need. These decisions are likely to reflect their own values and ideas, for instance about social equity and patients' worthiness. But these may not necessarily reflect the goals and ideals that the formal healthcare system aims to achieve.
• Finally, informal mobile phone use plugs gaps in the healthcare system but can also weaken the system. Storing and sharing of information on personal phones and through informal channels can create a ‘shadow IT’ (information technology) system where information about patient flow and logistics are not formally recorded. Healthcare workers may also be more distracted at work, for instance by calls from colleagues and family members or by social media. These types of challenges may be particularly difficult for weak healthcare systems.
How current is this evidence?
The evidence is current to August 2022.
By finding their own informal solutions to workplace challenges, healthcare workers can be more efficient and more responsive to the needs of patients, colleagues and themselves. But these solutions also have several drawbacks. Efforts to strengthen formal health systems should consider how to retain the benefits of informal solutions and reduce their negative effects.
Healthcare workers sometimes develop their own informal solutions to deliver services. One such solution is to use their personal mobile phones or other mobile devices in ways that are unregulated by their workplace. This can help them carry out their work when their workplace lacks functional formal communication and information systems, but it can also lead to new challenges.
To explore the views, experiences, and practices of healthcare workers, managers and other professionals working in healthcare services regarding their informal, innovative uses of mobile devices to support their work.
We searched MEDLINE, Embase, CINAHL and Scopus on 11 August 2022 for studies published since 2008 in any language. We carried out citation searches and contacted study authors to clarify published information and seek unpublished data.
We included qualitative studies and mixed‐methods studies with a qualitative component. We included studies that explored healthcare workers’ views, experiences, and practices regarding mobile phones and other mobile devices, and that included data about healthcare workers’ informal use of these devices for work purposes.
We extracted data using an extraction form designed for this synthesis, assessed methodological limitations using predefined criteria, and used a thematic synthesis approach to synthesise the data. We used the ‘street-level bureaucrat’ concept to apply a conceptual lens to our findings and prepare a line of argument that links these findings. We used the GRADE-CERQual approach to assess our confidence in the review findings and the line-of-argument statements. We collaborated with relevant stakeholders when defining the review scope, interpreting the findings, and developing implications for practice.
We included 30 studies in the review, published between 2013 and 2022. The studies were from high-, middle- and low-income countries and covered a range of healthcare settings and healthcare worker cadres. Most described mobile phone use as opposed to other mobile devices, such as tablets. We have moderate to high confidence in the statements in the following line of argument.
The healthcare workers in this review, like other ‘street-level bureaucrats’, face a gap between what is expected of them and the resources available to them. To plug this gap, healthcare workers develop their own strategies, including using their own mobile phones, data and airtime. They also use other personal resources, including their personal time when taking and making calls outside working hours, and their personal networks when contacting others for help and advice.
In some settings, healthcare workers' personal phone use, although unregulated, has become a normal part of many work processes. Some healthcare workers therefore experience pressure or expectations from colleagues and managers to use their personal phones. Some also feel driven to use their phones at work and at home because of feelings of obligation towards their patients and colleagues.
At best, healthcare workers’ use of their personal phones, time and networks helps humanise healthcare. It allows healthcare workers to be more flexible, efficient and responsive to the needs of the patient. It can give patients access to individual healthcare workers rather than generic systems and can help patients keep their sensitive information out of the formal system. It also allows healthcare workers to communicate with each other in more personalised, socially appropriate ways than formal systems allow. All of this can strengthen healthcare workers' relationships with community members and colleagues.
However, these informal approaches can also replicate existing social hierarchies and deepen existing inequities among healthcare workers. Personal phone use costs healthcare workers money. This is a particular problem for lower-level healthcare workers and healthcare workers in low-income settings as they are likely to be paid less and may have less access to work phones or compensation. Out-of-hours use may also be more of a burden for lower-level healthcare workers, as they may find it harder to ignore calls when they are at home. Healthcare workers with poor access to electricity and the internet are less able to use informal mobile phone solutions, while healthcare workers who lack skills and training in how to appraise unendorsed online information are likely to struggle to identify trustworthy information. Informal digital channels can help healthcare workers expand their networks. But healthcare workers who rely on personal networks to seek help and advice are at a disadvantage if these networks are weak.
Healthcare workers’ use of their personal resources can also lead to problems for patients and can benefit some patients more than others. For instance, when healthcare workers store and share patient information on their personal phones, the confidentiality of this information may be broken. In addition, healthcare workers may decide to use their personal resources on some types of patients, but not others. Healthcare workers sometimes describe using their personal phones and their personal time and networks to help patients and clients whom they assess as being particularly in need. These decisions are likely to reflect their own values and ideas, for instance about social equity and patient 'worthiness'. But these may not necessarily reflect the goals, ideals and regulations of the formal healthcare system.
Finally, informal mobile phone use plugs gaps in the system but can also weaken the system. The storing and sharing of information on personal phones and through informal channels can represent a ‘shadow IT’ (information technology) system where information about patient flow, logistics, etc., is not recorded in the formal system. Healthcare workers may also be more distracted at work, for instance, by calls from colleagues and family members or by social media use. Such challenges may be particularly difficult for weak healthcare systems.